Rod persuading reduces primary construct stability in lumbar interbody fusion in the osteoporotic spine – A biomechanical in-vitro study

IF 1.4 3区医学 Q4 ENGINEERING, BIOMEDICAL

Clinical Biomechanics Pub Date : 2025-05-17 DOI:10.1016/j.clinbiomech.2025.106563

Vincent J. Heck , Tobias Prasse , Juan Manuel Vinas-Rios , Andreas Prescher , Lajos Basten , Maximilian Weber , Peer Eysel , Nikolaus Kernich

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引用次数: 0

Abstract

Background

With the introduction of the pedicle screw-rod system and intervertebral cages, posterior spinal fusion has increasingly become a standard procedure in the treatment of degenerative spinal conditions.

The aim of this study is to investigate the influence of rod persuading in lumbar spinal fusion constructs on the pullout strength of pedicle screws, considering different bone qualities.

Methods

Ten fresh-frozen lumbar spines (L1–5) from 10 cadaveric donors were initially included. All specimens were examined at the beginning of the study both macroscopically and by computed tomography scans (HR-CT, Siemens) to ensure specimen integrity, and the mineral bone density by using Hounsfield units. One specimen had to be excluded prior to biomechanical testing due to a vertebral fracture extending into the pedicle, leaving a total of 9 specimens available for the study.

Findings

The displacement of the screws during the pullout test was significantly greater in the osteoporotic specimens after rod persuader use (Group 2), compared to the non-osteoporotic specimens (3.7 ± 0.7 mm vs. 5.5 ± 0.4 mm, p = 0.0486). This difference was not observed in the non-rod persuader group. Overall, rod persuading decreased the displacement distance until tensile load to screw failure by 29 %.

Interpretation

The use of the rod persuader reduces the pedicle screw pullout strength, thereby compromising the construct stability. This reduction is particularly significant in osteoporotic vertebral bodies, highlighting the need for careful consideration of rod persuader use in this patient population.

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一项体外生物力学研究表明，在骨质疏松性脊柱椎体间融合术中，棒诱导降低了初级结构的稳定性

随着椎弓根螺钉-棒系统和椎间笼的引入，后路脊柱融合术日益成为治疗脊柱退行性疾病的标准手术。本研究的目的是在考虑不同骨质量的情况下，探讨腰椎融合装置中棒诱导对椎弓根螺钉拔出强度的影响。方法采用10例尸体供体的新鲜冷冻腰椎（L1-5）。在研究开始时，所有标本均通过宏观和计算机断层扫描（HR-CT, Siemens）进行检查，以确保标本的完整性，并使用Hounsfield单位检查矿物骨密度。由于椎体骨折延伸至椎弓根，在生物力学测试之前必须排除一个标本，总共留下9个标本可供研究。结果：与非骨质疏松患者相比，骨质疏松患者在使用棒说服器后拔牙试验中螺钉的位移明显大于非骨质疏松患者（3.7±0.7 mm vs. 5.5±0.4 mm, p = 0.0486）。这种差异在非棒说服组中没有观察到。总体而言，杆说服减少了位移距离，直到拉伸载荷到螺杆失效29%。使用棒引导器会降低椎弓根螺钉的拔出强度，从而影响结构的稳定性。这种减少在骨质疏松性椎体中尤为显著，强调了在这类患者群体中使用棒诱导器的必要性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Biomechanics 医学-工程：生物医学

CiteScore

3.30

自引率

5.60%

发文量

189

审稿时长

12.3 weeks

期刊介绍： Clinical Biomechanics is an international multidisciplinary journal of biomechanics with a focus on medical and clinical applications of new knowledge in the field. The science of biomechanics helps explain the causes of cell, tissue, organ and body system disorders, and supports clinicians in the diagnosis, prognosis and evaluation of treatment methods and technologies. Clinical Biomechanics aims to strengthen the links between laboratory and clinic by publishing cutting-edge biomechanics research which helps to explain the causes of injury and disease, and which provides evidence contributing to improved clinical management. A rigorous peer review system is employed and every attempt is made to process and publish top-quality papers promptly. Clinical Biomechanics explores all facets of body system, organ, tissue and cell biomechanics, with an emphasis on medical and clinical applications of the basic science aspects. The role of basic science is therefore recognized in a medical or clinical context. The readership of the journal closely reflects its multi-disciplinary contents, being a balance of scientists, engineers and clinicians. The contents are in the form of research papers, brief reports, review papers and correspondence, whilst special interest issues and supplements are published from time to time. Disciplines covered include biomechanics and mechanobiology at all scales, bioengineering and use of tissue engineering and biomaterials for clinical applications, biophysics, as well as biomechanical aspects of medical robotics, ergonomics, physical and occupational therapeutics and rehabilitation.